Physiotherapy

Evidence pyramid

The evidence-based pyramid provides a visual depiction of forms of research from least reliable (base of pyramid) to most reliable (top of pyramid).Ingham-Broomfield, R. (2016). A nurses' guide to the hierarchy of research designs and evidence. The Australian Journal of Advanced Nursing, 33 (3) pp 38-43.

Comparative Grid of the Seven Levels of Evidence

Slightly more reliable but there is a potential for bias in recalling information and the quality may be affected if the information is collected retrospectively

Level 5

Cohort Studies

Becoming more reliable. Observational studies are good at answering questions about prognosis, diagnosis, frequency and aetiology but not questions regarding the effect of an intervention

Level 4 Middle

Random Control Trials

Very Reliable/ Gold Standard. Random Controlled Trials are able to quantify the effects of intervention, hence they are higher up the pyramid than Cohort Studies

Level 3

Critically-Appraised Individual Articles (Article Synopses)

Increasing reliability of findings. A synopses is the evidence of an individual article with an expert telling you its strengths. This is less reliable than Critically Appraised Topics as there is less evidence on single articles than in a synthesis of the topic using several papers.

Level 2

Critically Appraised Topics (Evidence Syntheses)

Very high reliability. Synthesising research publications entails the categorising of a series of related studies, analysing and interpreting their findings and then summarising those findings in to unified statements. The potential lack of standardisation can undermine the validity.

Level 1a/1b Apex

Systematic Reviews and Meta-analysis

The most reliable of all. Systematic reviews and Meta analyses of primary research into human health care and health policy are recognised internationally as the highest standard in evidence-based care.

Source: Ingham-Broomfield, R. (2016). A nurses' guide to the hierarchy of research designs and evidence. The Australian Journal of Advanced Nursing, 33 (3) pp 38-43.